March 29, 2021 ☼ The Intersection ☼ Covid-19 ☼ public policy

Direct vaccination to spike the surge

Focusing on hotspots instead of spreading our vaccination efforts too thinly will help us quell the current surge in infections

Mint This is from The Intersection column that appears every other Monday in Mint.

In the past month, we have learnt two things about the pandemic. First, that relaxed behaviour by previously better-protected populations across the country is causing a surge in new coronavirus infections; and second, that the speed of the vaccination programme is constrained by hesitancy, mismatch of demand and supply, and perhaps short-term challenges in scaling up vaccine production. In the light of what we know now, there is a case to review the national vaccination strategy and direct it at quelling a widespread second wave.

Instead of pursuing a progressive nationwide expansion of vaccination prioritized by age-groups, the Narendra Modi government should open up vaccination to all adults in cities and districts where there is a surge in new covid cases. This is not only the most effective way to use available vaccine supplies, but also to avoid pressure on the national vaccination programme by reducing the risks of more serious second waves elsewhere in the country.

Not only should the government make every adult in the worst affected areas eligible for vaccination, but massively expand the vaccination points by permitting all registered clinics to administer the vaccine. As the government is currently the sole distributor of vaccines, it should ensure that these worst-hit areas are supplied as a matter of urgent priority. India would be better off with a dynamic vaccination strategy of ‘quelling the surge’ wherever it occurs.

Contrary to what its critics say, India’s vaccination programme has demonstrated a good mix of caution and flexibility so far. A gradual ramp-up was justified, given that two new vaccines are being administered to hundreds of millions of adults. So is the careful expansion of vaccination points and age-groups. But this programme was drawn up when many experts and analysts—including your columnist—didn’t expect such a severe second wave. Circumstances have changed. What the National Expert Group on Vaccine Administration Working on Management of Covid-19 Vaccine Roll-Out (Negvac) and the Union cabinet must now take into account is the risk that the current path of the programme might not be fast enough and focused enough to prevent second waves in many more parts of the country. To use a military metaphor, we would do better to adopt a war footing, concentrating forces to win decisive battles, instead of spreading them thinly all across the front. Indeed, the very case for centralized management of national vaccination is the ability it grants to focus resources in a strategic manner across regions and populations.

The main disadvantage of central planning is that it can never equal the market’s efficiency in matching demand and supply. Cases of wasted vaccines that worry our public officials would disappear if allocations were done by markets instead of administrators. Similarly, raising the daily vaccination rate and extending the coverage require private-sector involvement. No public service in India has been delivered by the government alone. There is some justification in keeping vaccines under government control in the early stages, when supply is limited and the vaccines’ impact on the population unknown. But once supply is no longer a serious constraint—perhaps a quarter hence—vaccination should be fully deregulated. As long as a good vaccine is available free at government hospitals and inexpensively at private ones, opening up the market for vaccinations will enable India to reach its targets faster. It makes little sense for the government—even if it were not facing severe fiscal constraints—to insist on subsidizing vaccines for people who can easily afford them. The only requirement would be to ensure all vaccinations are registered on a reinforced Co-Win backbone.

In many Indian cities today, the younger population is more mobile and exposed, as it is driving economic activity. This is desirable, as it fuels a national recovery from the devastation caused by the pandemic. Yet, this is the very population that is last in queue for the vaccine, while being both vulnerable to the disease as well as responsible for its spread. The older population is more vulnerable, yes, but is relatively less required to move around. In the face of a surge in infections, from both epidemiological and economic standpoints, it is better to prioritize higher-risk younger adults for vaccination and isolate the older ones until more supplies come aboard.

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This is arguably the most ethical approach too, as public policy ought to be judged more by outcomes, less by intentions, and least by emotions. Redirecting limited vaccine supplies to highly-affected populations will mean that other populations and regions will have to wait longer. This in itself is not inequitable, for we must consider the network effects of an epidemic. Quelling a surge helps not only the population and a region that is prioritized, but also others who might face their own surges if the situation is not tackled. In any event, it is now only a matter of a few months before adequate supplies of several vaccines are available. But the next few weeks can save a lot of people across the country from avoidable suffering if enough vaccines reach the few affected districts in time.

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